Living With Food Allergies

Tree Nut Allergy

Tree nut allergy is the second most common allergy in infants and young children. Approximately 0.4- 0.5% of American children have a tree nut allergy. Tree nuts are a common allergen reported to cause fatal and near-fatal allergic reactions.

Tree nut allergy is usually life-long once acquired. Approximately 9% of children allergic to tree nuts may outgrow their allergy.

Children with a tree nut allergy must avoid that tree nut and all products containing that type of tree nut. Children with a tree nut allergy also must avoid anything containing traces of ingredients containing that tree nut. There is a potential of tree nut products having cross-contact other tree nuts and with peanuts. For this reason, your child's doctor may advise you to avoid all tree nuts and peanuts.

How to Read a Label for Tree Nuts

Always read the entire ingredient label to look for the names of the tree nut(s) you need to avoid. Tree nut ingredients may be within the list of the ingredients. Or tree nuts could be listed in a “Contains” statement beneath the list of ingredients. Examples are "Contains Walnut" or "Contains Almond". This is required by the federal Food Allergen Labeling and Consumer Protection Act (FALCPA). Learn more about the U.S. food allergen labeling law.

FALCPA requires that all packaged foods regulated by the FDA must list the common names of tree nuts clearly on the ingredient label if it contains tree nuts. Advisory statements such as “may contain hazelnuts” or “made in a facility with tree nuts” are voluntary. Advisory statements are not required by any federal labeling law. Discuss with your doctor if you may eat products with these labels or if you should avoid them.

Did you know that marzipan, mortadella and mandelonas all contain tree nuts? The FDA food allergen label law requires foods to state if they contain a top 8 allergen such as tree nuts. But, there are many foods and products that are not covered by the law, so it is still important to know how to read a label for tree nut ingredients. Products exempt from plain English labeling rules: (1) Foods that are not regulated by the FDA. (2) Cosmetics and personal care items. (3) Prescription and over-the-counter medications. (4) Toys, crafts and pet food.

CONTAIN TREE NUTS

The following ingredients found on a label indicate the presence of tree nuts. All labels should be read carefully before consuming a product, even if it has been used safely in the past.

TREE NUTS ARE SOMETIMES FOUND IN

However, if the product is an FDA regulated food, the common tree nut name must appear on the label.

*Coconut

The FDA lists coconut as a tree nut. In fact, coconut is a seed of a drupaceous fruit. Most people allergic to tree nuts can safely eat coconut. Coconut allergy is reasonably rare. If you are allergic to tree nuts, talk to your allergist before adding coconut to or eliminating coconut from your diet.

Cross Reactivity: Do You Need to Avoid Other Foods?

Cross-reactivity occurs when the proteins in one food are similar to the proteins in another. When that happens, the body's immune system sees them as the same.

Tree nuts are in a different plant family than peanuts. Peanuts are legumes and are not related to tree nuts (almonds, walnuts, cashews, etc.). However, about 35% of peanut-allergic toddlers in the U.S. have or will develop a tree nut allergy. Doctors often recommend that young children avoid tree nuts if they are allergic to peanuts. This is because it is fairly common to be "co-allergic" to tree nuts if a child is allergic to peanuts.

There is a high degree of cross-reactivity between cashew and pistachio and between walnut and pecan. Most people who are allergic to one tree nut are not allergic to all tree nuts. But some doctors will advise their patients to avoid all tree nuts if allergic to one or more tree nuts. Check with your doctor to find out if you need to avoid all tree nuts.

Nutrition for a Nut-Free Diet

Tree nuts are a good source of protein, vitamins and minerals in a child's diet. However, if your child needs to avoid nuts of any type, they should not be at nutritional risk since there are many other sources of protein to eat instead.

Tree Nut Substitutions

It is very easy to replace nuts in a recipe. There are many seeds and seed products available including sunflower butter and pumpkin seed butter. Roasted chickpeas can replace nut snacks. Pretzels can substitute for pecans in pecan pie.